“I see a miracle every day in this unit,” said Lore Rogers, RN, BSN. A nurse at the Joseph M. Still Burn Center at Doctors Hospital in Augusta for 23 years, she knows those miracles don’t just happen. They’re encouraged by the skill and compassion of a staff dedicated to doing whatever it takes to heal patients.
When someone with a large burn arrives at the burn center, often by helicopter from miles away, it takes a team to treat that patient. A surgeon, a nurse practitioner, a physician’s assistant, two nurses and the wound care team of three technicians may work for five to six hours to stabilize the patient.
Most likely, the patient will be hooked up to a ventilator, an artificial kidney machine, pumps to work the heart and administer medication, and monitoring devices to keep that person alive and comfortable. The patient also is placed in a speciallydesigned bed to avoid developing ulcers.
“It’s like an orchestra,” Rogers said. “Everyone has his part to play and we don’t even have to say anything because we’ve worked together for years. My part is just one little bitty piece, but I’m proud to be a part of the team. I was born to be a burn nurse — it’s my life’s calling.”
Like many members of the staff, burn care was not Rogers’ first calling; she was asked to fill in on the unit and never left. “It’s a unique aspect of nursing,” she said. “We see patients come in so critically injured — we nurse them through the serious and the good times and then we see them leave.
“It’s important not just to save their lives, but to give them their lives back. Burn care has evolved into a very sophisticated form of medicine.” At Doctors Hospital, it started in 1976, when Augusta plastic surgeon Dr. Joseph M. Still was called to the emergency room to treat a 48-year-old man with thermal burns covering 40 percent of his body.
“It didn’t take us long to realize that the hospital didn’t have the people or materials to treat him,” Still said. “We tried to transfer him to other facilities, but the man was indigent and no one would take him.
“If everyone had that opinion, then a lot of people weren’t going to be treated. It seemed like there was a need for a burn unit in this community.” It took Still two years to convince the hospital to build a burn center because burn victims were highmaintenance, high-cost patients who were smelly, messy, loud and in pain.
“A burn is not just an injury of the skin,” Still explained. “First the capillary system dilates. The fluid in the vascular tree leaks out, depriving the heart of fluid, so blood pressure drops and the patient goes into shock. If you replace too much fluid, then you get water on the lungs.
“Wounds infect easily, so you need medicine, but that can cause problems with the liver. . . A burn affects all the organs in the body and managing it is a 24-hour, seven-day-a-week job.”
Still started with one bed, then three, eventually expanding to an entire floor.
Named for its founder and director, the Joseph M. Still Burn Center was built in 1982. It contains a 25-bed critical care unit, an 18-bed hospital unit, operating rooms and an outpatient clinic. Through a partnership with the Southeastern Firefighters Burn Foundation, the center also houses the Shirley Badke Retreat, which provides families of patients with free housing and services.
A coalition of churches in the area supplies meals daily to the waiting areas. “It helps to be positive, and families play a big role in patient recovery. We encourage them to come,” Still said.
Serving a need
While most burn centers are attached to university hospitals, the Augusta center is a private, for-profit facility that never turns down a patient, about half of whom have little or no insurance.
The center admitted 2,000 patients from around the Southeast last year and is nationally renowned for its 96 percent survival rate, reduced patient stays, cutting-edge research and treatment innovations. It’s been the setting for many clinical trials for antiinfective drugs, hyperbaric oxygen therapy, skin substitutes and other medical technology — research that helps patients all over the world.
“In the early 1970s, when I first worked with burn patients, all you heard was screaming, because we didn’t understand pain management. We have better techniques now,” said Dennis Dadig, OT, director of the occupational/physical therapy department.
Still helped pioneer early burn excision and grafting, often operating within 24 hours of the burn. “We thought we had to wait two or three weeks until the patient was stable, but it turns out that they are stable and it’s easier to operate earlier,” Still said.
Once, burn patients were put in a whirlpool bath and vigorously scrubbed twice a day. Now debriding of dead skin is often done in the operating room under anesthesia. More effective anti-infection medications, new advances in temporary and artificial skin and dressings that last four to seven days cut down on complications.
Another healing innovation is the hyperbaric chamber (originally developed to treat people with the bends), which increases the concentration of oxygen in the body, kills bacteria and causes blood cells to grow.
A successful graft must come from the patient’s own skin, but it’s now possible to take a piece of skin the size of a postage stamp and send it to a Boston company that can grow eight square feet of skin in three weeks.
“It’s a very expensive process, but if it’s the only thing that will save a patient, my philosophy has always been you do whatever it takes,” Still said.
Nationwide model
Knowing the complexity of burns, Still adopted a multidisciplinary approach to care that has become a model worldwide. The staff includes surgical, medical, orthopedic, reconstructive, occupational/physical therapy disciplines, as well as nutritional technicians and psychiatrists to address the emotional trauma of the patient. Everyone plays a role and feels free to make notes on the chart.
“This is a great place to work as a physician’s assistant,” said Beretta Craft-Coffman, PA-C, lead physician assistant. “We see patients, assist in surgery, manage the clinic, write discharge plans. You have a lot of autonomy in this environment and gain a lot of surgical expertise.
“You also get to know your patients and their families.”
Dadig and other occupational and physical therapists work with patients to prevent contraction and scarring. They devise plans to increase mobility and a return to everyday functions, while encouraging and educating families.
“Our biggest challenge is to motivate patients to do what they need to do to help themselves, because they’re hurting all the time,” Dadig said. “Every day is different. I’ve been here 13 years and I’m still learning things. Our goal is for patients to have the same function levels that they had before the accident. Seeing them walk out of here is the reward.”
Walking through the halls, Still calls “How ya doing?” to a patient swathed in bandages and hooked to multiple machines and monitors. There’s no answer.
“He’s still unconscious,” Still said. But not for long, if the staff has its way.
Still is proudest of the quietness of the halls, where patients are comfortable and healing, and the confidence of his staff, who deal with emergency high-risk, high-mortality situations every day.
“Our patients get up and go on to lead quality lives,” he said.